General interest items edited by Janice Flahiff

Imagine that the next time your doctor orders a round of tests, in addition to cholesterol and vitamin D, she also orders a genome sequence. It sounds like science fiction, but the day might come sooner than you think.

With concerns about the cost of health care, though, can we afford precision medicine?

In certain instances, precision medicine can actually save money. For example, if patients can be screened for drug hypersensitivity before being prescribed certain drugs, they won’t have to be treated later, which is better for patients and cuts down on costs. A similar approach works for choosing treatments.

“When you use a therapy to target only the individuals who will benefit, you avoid wasting drugs or other resources on people who you know won’t get any benefit, and who might actually be harmed,” said David Threadgill, Ph.D., professor and holder of the Tom and Jean McMullin Chair of Genetics at the Texas A&M Health Science Center College of Medicine and director of the Texas A&M Institute for Genome Sciences and Society.

Of course, it’s not quite that simple. “Whether the economics works out in favor of precision medicine depends on two things: the difficulty and the cost of finding the best candidates who will benefit from specific, tailored treatments,” said Robert L. Ohsfeldt, Ph.D., health economist and professor in the Department of Health Policy & Management at the Texas A&M School of Public Health. “You have to know a lot about the disease process and how individual characteristics—genetics and environmental factors like diet or exposure to toxins—mediate the treatment response.”

“Astudy by researchers at Columbia University’s Mailman School of Public Health looked at the associations between firearm-related laws and firearm homicides, suicides, and unintentional injuries and deaths. The paper is the first to explore the evidence from around the world on gun laws and gun violence to determine whether gun restrictions help reduce gun deaths. While the research did not conclusively prove that restrictions, or relaxation of laws, reduce gun deaths, the results indicate that gun violence tended to decline after countries passed new restrictions on gun purchasing and ownership. Findings are published online in the February issue of Epidemiologic Reviews.

The researchers reviewed the findings from 130 studies conducted from 1950 to 2014 in 10 countries that had overhauled their gun law, mostly in the developed world, including the U.S., Australia, and Austria. A few studies looked at gun laws in middle-income countries, including Brazil, Colombia and South Africa.

“In most countries, we saw evidence of reduction in the firearm death rates after the enactment of firearm legislation” said Julian Santaella-Tenorio, a doctoral student in Epidemiology at Columbia University’s Mailman School and the study’s lead author.

Santaella-Tenorio and his Columbia co-authors, Professors Magdalena Cerdá and Sandro Galea, also found evidence that specific laws, such as background checks and rules on storage, reduced specific kinds of gun deaths including intimate partner homicides and firearm unintentional deaths in children, respectively.

By comparison, laws in place about carrying concealed weapons or standing your ground either had no effect on gun deaths or increased gun violence. “While our review is not proof that gun laws reduce violence, and also taking into account that for some countries there are very few papers examining firearm laws effects, we did see evidence showing an association between firearm laws and a decline in firearm homicide and suicide rates,” noted Santaella-Tenorio.

“Since we limited our review to changes in firearm policy and not ownership in general or other types of policy, the debate should not end here.”

When a solution to a problem seems to have come to you out of thin air, it turns out you’ve more than likely been struck with the right idea, according to a new study.

A series of experiments conducted by a team of researchers determined that a person’s sudden insights are often more accurate at solving problems than thinking them through analytically.

“Conscious, analytic thinking can sometimes be rushed or sloppy, leading to mistakes while solving a problem,” said team member John Kounios, PhD, professor in Drexel University’s College of Arts and Sciences and the co-author of the book “The Eureka Factor: Aha Moments, Creative Insight and the Brain.” “However, insight is unconscious and automatic — it can’t be rushed. When the process runs to completion in its own time and all the dots are connected unconsciously, the solution pops into awareness as an Aha! moment. This means that when a really creative, breakthrough idea is needed, it’s often best to wait for the insight rather than settling for an idea that resulted from analytical thinking.”

Experiments with four different types of timed puzzles showed that those answers that occurred as sudden insights (also described as Aha! moments) were more likely to be correct. Moreover, people who tended to have more of these insights were also more likely to miss the deadline rather than provide an incorrect, but in-time, answer. Those who responded based on analytic thought (described as being an idea that is worked out consciously and deliberately) were more likely to provide an answer by the deadline, though these last-minute answers were often wrong.

Once in a month my husband and I pack Amos in his stroller and walk a few blocks to our closest health care center. We take the elevator to the fourth floor and enter Neuvola, the maternity and child care clinic, or ‘Place for Advice’ as translated freely from the Finnish word.

Neuvola is a Finnish public health care service available for all expectant mothers and children for free.

The numbers for maternal and child mortality used to be staggering in Finland as well. Just 80 years ago, out of 1000 children a total of 95 died before reaching the age of 5. Now that number is less than 3, one of the lowest in the whole world. Similarly, the rate of maternal deaths used to be high, with 400 mothers dying per 100,000 births. Today, such deaths do basically not occur.

Who are we to thank for this?

The story of Neuvola dates back to the 1920s.

Mr. Arvo Ylppö, a Finnish pediatrician, was determined to decrease infant mortality in Finland. He got his motivation from Germany where he studied and observed, for instance, that the cause of death for prematurely born infants can be traced to treatable conditions instead of simple underdevelopment.

The ideas he then implemented in Finland are, in essence, preventive health care measures.

He supported efforts to educate health care professionals, along with midwives, to municipalities. The services provided by Neuvola were to be free of charge and voluntary. At its core were to be the provision of guidance for mothers and families, a complete vaccination programme as well as the detection of abnormalities in a child’s development as early as possible.

These remain the activities of Neuvola even today.

Neuvola started small, but today itreaches practically all expectant mothers and children in Finland from their birth to the beginning of primary education which is usually at the age of 7. It has been a tremendous success story. My mother used Neuvola services, now I do too. It is a privilege shared by many generations.

It is not an exaggeration to say that Finland is one of the best countries in the world for parents.

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About

This blog presents a sampling of health and medical news and resources for all. Selected articles and resources will hopefully be of general interest but will also encourage further reading through posted references and other links. Currently I am focusing on public health, basic and applied research and very broadly on disease and healthy lifestyle topics.

Several times a month I will post items on international and global health issues. My Peace Corps Liberia experience (1980-81) has formed me as a global citizen in many ways and has challenged me to think of health and other topics in a more holistic manner.

Do you have an informational question in the health/medical area?
Email me at jmflahiff@yahoo.comI will reply within 48 hours.

My professional work experience and education includes over 15 years experience as a medical librarian and a Master’s in Library Science. In my most recent position I enjoyed contributing to our library’s blog, performing in depth literature searches, and collaborating with faculty, staff, students, and the general public.

While I will never be be able to keep up with the universe of current health/medical news, I subscribe to the following to glean entries for this blog.

Krafty (Medical)Librarian,” a collection of writings from Michelle Kraft on items of interest to medical librarians. She tends to write on technology and medical libraries but she also writes about things in general on librarianship, medicine and health”